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General NPI Number Information
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NPI Number | 1811015084
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Entity Type | Organization
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Legal Business Name | NORTHWEST ORAL & MAXILLOFACIAL SURGERY INC
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Dates
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Enumeration Date | 03/27/2007
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Last Update Date | 10/13/2011
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Provider Practice Location Address
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Address Line | 1600 W CENTRAL RD
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City | ARLINGTON HEIGHTS
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State | IL
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Zip | 60005
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Country | US
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Telephone | 847-392-6220
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Fax | 847-392-6236
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Provider Business Mailing Address
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Address Line | 1600 W CENTRAL RD
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City | ARLINGTON HEIGHTS
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State | IL
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Zip | 60005
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Country | US
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Telephone | 847-392-6220
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Fax | 847-392-6236
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Authorized Official
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Title or Position | ORAL SURGEON
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Name | DR. MATTHEW E GAUTHIER
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Credential | DDS
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Telephone | 847-392-6220
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 019019734
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 019015876
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 019025795
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License Number State | IL
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Taxonomy #4
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 021001087
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License Number State | IL
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Taxonomy #5
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 021001407
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License Number State | IL
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Taxonomy #6
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 021001157
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License Number State | IL
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Taxonomy #7
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 021002123
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License Number State | IL
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Taxonomy #8
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 019016047
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License Number State | IL
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